経過を観察しえた早期胃細網肉腫の1例―レ線および内視鏡所見を中心として

A Case of Early Gastric Reticulum-cell Sarcoma: follow-up study with x-ray and gastroendoscope during the early stage

　胃原発の肉腫については1840年Landsbergが円形細胞肉腫を初めて報告した．わが国では今が1901年同疾患を報告して以来，今日までに300例以上の発表^1)～3)がある．胃原発の悪性腫瘍のうち肉腫は癌腫に次ぐが，頻度は2％内外とされている^1)～6)．わが国では肉腫の中では細網肉腫が最も多いといわれるが，その頻度からいえばまれな疾患である．しかも，早期胃癌に準じて浸潤が粘膜下組織にとどまるものを早期肉腫とすると，その報告は極めて少ない^7)～12)．

　筆者らは約4カ月間にわたってレ線ならびに内視鏡的に経過を観察し得た早期胃細網肉腫の1例を経験し，若干の知見を得たのでレ線像，内視鏡所見および組織学的所見について報告し，2，3の考察を加えたい．

　A case of carly gastric reticulum-cell sarcoma was followed up for four months with x-ray and endoscopic examinations.

　A 39-year-old man complaining of epigastralgia was found to harbor four lesions in the stomach lying scattered from the lower part of the corpus down to the prepyloric region of the posterior wall along the major axis.

　The lesions were shown definitely by x-ray at the time of ulcer formation. They were noticed by x-ray before the operation as multiple lesions having peculiar-shaped, irreglar ulcer shadows with unusual gathering folds and localized embankment. This roentgenological findings were suppoesed to be characteristic features of a type of early gastric reticulum-cell sarcoma.

　Growth of tumors with ulceration was observed endoscopically as well. Final examination before the operation revealed these lesions as protruded ones with ulcers. Margins of the lesions were elevated gradually from the surrounding mucosa. The protrusions, of rugged and discolored surface, had no bridging folds over them. The bottoms of ulcers were also rugged and covered with white coat. Endoscopic observations as mentioned above and developlment of ulceration in the course of illness led the authors to suspect that these might be characteristic features of a type of early gastric reticulum-cell sarcoma. Pathologically, depths of four ulcerative lesions were all Ul-Ⅱ, and reticulum-cell sarcomas were localized in the edge of each ulcer, invading only the adjacent submucosal layer. Microscopically, each lesion was independent from one another, and regional lymph nodes were not involved, nor was there any swelling of superficial lymph nodes. No abnormal findings were seen either in lymphangiogram, or biopsy specimens from scalene node and the liver as well as in myelogram.

　From these findings, this case was diagnosed as primary early and localized gastric reticulum-cell sarcoma with quadricentric development.